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Approach to Depression in Patients with Brain Diseases: Stroke, Parkinson’s Disease, and Dementia

  • Kyung Bong Koh
Chapter

Abstract

The physical and/or psychological sequelae caused by stroke, Parkinson’s disease, and dementia may be devastating for both the patient and family. Depression during these illnesses not only complicates diagnosis and treatment but also hinders therapeutic efforts. SSRIs and tricyclic antidepressants are known to be effective in poststroke depression. These antidepressants should be continued at least for 4 months after initial recovery and should be changed if no response is seen after 6 weeks. Psychotherapy including cognitive behavioral therapy can be tried for patients with milder depression and those with side effects or contraindications to the use of antidepressants. Multidisciplinary and integrative approaches are recommended for assessing and treating poststroke depression. Tricyclic antidepressants as well as bupropion and SSRIs help improve depression in patients with Parkinson’s disease. However, bupropion, SSRIs, and venlafaxine are preferred drugs for depressed patients with dementia because they cause less cognitive impairment and sedative action than tricyclic antidepressants. Overall, therapeutic approaches to Parkinson’s disease or dementia comorbid with depression may involve a combination of psychopharmacological treatment and psychotherapeutic interventions including behavioral treatment.

Keywords

Stroke Parkinson’s disease Dementia Depression Mechanisms of poststroke depression Integrative approach Multidisciplinary approach Psychopharmacotherapy Psychotherapy 

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Kyung Bong Koh
    • 1
  1. 1.Department of PsychiatryYonsei University College of MedicineSeoulKorea

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